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Review
...one of the most important books in the field of psychiatry published in the last few years...a brilliant book with a significance well beyond its narrow but important subject. (Spectator )
This wonderful book will alter professional thinking. (Nursing Standards )
...an interesting and thought-provoking book that underscores the need to examine more fully each patient's psychological illness and the factors contributing to it...[a good book for] anyone interested in understanding depression more fully and the place normal sadness has in our society. (Doody's Notes )
...[this book] could alter the official definition of depression, change the way we get mood-enhancing drugs, and clarify how effectively our culture delivers well-being. (Reason Magazine )
Allan Horwitz and Jerome Wakefield's important book... is part of a gathering blowback against the pathologisation and medicalisation of the ordinary human condition of sadness after loss... what they do accomplish in critiquing psychiatric diagnosis of depression is important enough to make much of this book required reading for depression researchers and clinicians. (The Lancet )
...a work of deep scholarship... (Hugh Freeman, Times Literary Supplement )
This wonderful book will alter professional thinking. (Nursing Standards )
...an interesting and thought-provoking book that underscores the need to examine more fully each patient's psychological illness and the factors contributing to it...[a good book for] anyone interested in understanding depression more fully and the place normal sadness has in our society. (Doody's Notes )
...[this book] could alter the official definition of depression, change the way we get mood-enhancing drugs, and clarify how effectively our culture delivers well-being. (Reason Magazine )
Allan Horwitz and Jerome Wakefield's important book... is part of a gathering blowback against the pathologisation and medicalisation of the ordinary human condition of sadness after loss... what they do accomplish in critiquing psychiatric diagnosis of depression is important enough to make much of this book required reading for depression researchers and clinicians. (The Lancet )
...a work of deep scholarship... (Hugh Freeman, Times Literary Supplement )
Product Description
The Loss of Sadness argues that the increased prevalence of major depressive disorder is due not to a genuine rise in mental disease, but to the way that normal human sadness has been 'pathologised' since 1980. That year saw the publication of the landmark third edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which has since become a dominant force behind our current understanding of mental illness overall. As concerns at least major depression, the authors argue that the DSM's definition of the condition is too broad and that as a result virtually all research and clinical approaches to the condition have been based on a flawed understanding about it. The social, political, and scientific implications of this are far-reaching - from the overselling of antidepressants to treat ordinary sadness, as Big Pharma exploits the DSM for its own purposes; to intrusive and expensive depression screening programs at all levels of society, as well-meaning but misguided initiatives translate the DSM into simple terms to catch any whiff of depressive pathology in our midst; and funded research into the 'epidemic' of depression, which advances the field very litttle and the public even less. Ultimately, the definition of depression that is in operation today has formed the basis for an entire system of social control (e.g. community-wide screening initiatives, intrusive public health policy) that benefits psychiatry, primary care providers, and the pharmaceutical and insurance industries by turning everyone else into a potential consumer of services, needed or not. The authors do recognise that depression is a devastating illness that affects some people. Their chief concern is with the use of this diagnosis as a catch-all for anyone who has experienced sadness for more than a few weeks at a time. The result is a pointed yet nuanced critique of modern psychiatry that will stir controversy of the sort that will reacquaint us with sadness as a primary human emotion and that could productively influence the way that depression the actual illness is characterised in the future.
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Most Helpful Customer Reviews
13 of 14 people found the following review helpful
Format:Hardcover
Written by Allan Horvitz and Jerome Wakefield, both distinguished University Professors working in the USA, 'The Loss of Sadness' is a pointed and persuasively argued critique of the conflation between what the authors describe as on the one hand:- (A) 'normal' sadness/sorrow that arises in reaction to negative events/social stressors in one's life such as relationship difficulties, job losses etc and is in fact a natural response to loss and:- (B) True 'Depressive Disorder' which either has no apparent cause or is grossly disproportionate to the apparent cause and which does not remit when the person's social circumstances change, stressful situations end or simply go away with the passage of time but seems to have 'a life of it's own.'
The authors argue that the Bible of American Psychiatry, the Diagnostic and Statistical Manual (DSM) - which lists all the different mental disorders and sets the specific criteria for their diagnosis - has, since it's revision and major overhaul in 1980, set the stall for this erroneous conflation by dramatically inflating the number of people diagnosed with Depression (and subsequently treated with Anti-Depressants of course) through a simple change in diagnostic criteria that allowed for the first time, and in the name of diagnostic RELIABILITY, a diagnosis of Depression to be made purely on the basis of symptoms alone. In this case five symptoms from a checklist of nine and then solely for a period of two weeks.
The criteria set in place by DSM has one exclusion criteria and that is that the symptoms are not better accounted for by Bereavement, which the authors state is the 'definition's only acknowledgement that some instances of normal intense sadness might satisfy the symptomatic criteria.' The central flaw of the defintion and the central thesis of the book is that the DSM defintion of Depression fails to take into account the context in which the person's symptoms emerged and thus fails to exclude intense sadness, other than in reaction to the death of a loved one, that arises from the way human beings NATURALLY respond to major losses.
The authors therefore argue that: the exclusion criteria should be expanded to take into account of the myriad circumstances other than bereavement that triggers 'normal sadness' and that would be better categorised as social problems/problems of living. The authors emphasise a truly VALID diagnosis of Depression can only be made when the context of the person's life is taken fully into account and thus the tickbox/checklist criteria of DSM is insufficient for it's purpose.
This might just be the most important book written about Depression since Robert Burton's 'Anatomy of Melancholy' and I would urge anyone with an interest in the subject to read it and take note for the implications of their argument are far-reaching. Also recommended reading on a similiar vein is David Healy's 'The Antidepressant Era.'
The authors argue that the Bible of American Psychiatry, the Diagnostic and Statistical Manual (DSM) - which lists all the different mental disorders and sets the specific criteria for their diagnosis - has, since it's revision and major overhaul in 1980, set the stall for this erroneous conflation by dramatically inflating the number of people diagnosed with Depression (and subsequently treated with Anti-Depressants of course) through a simple change in diagnostic criteria that allowed for the first time, and in the name of diagnostic RELIABILITY, a diagnosis of Depression to be made purely on the basis of symptoms alone. In this case five symptoms from a checklist of nine and then solely for a period of two weeks.
The criteria set in place by DSM has one exclusion criteria and that is that the symptoms are not better accounted for by Bereavement, which the authors state is the 'definition's only acknowledgement that some instances of normal intense sadness might satisfy the symptomatic criteria.' The central flaw of the defintion and the central thesis of the book is that the DSM defintion of Depression fails to take into account the context in which the person's symptoms emerged and thus fails to exclude intense sadness, other than in reaction to the death of a loved one, that arises from the way human beings NATURALLY respond to major losses.
The authors therefore argue that: the exclusion criteria should be expanded to take into account of the myriad circumstances other than bereavement that triggers 'normal sadness' and that would be better categorised as social problems/problems of living. The authors emphasise a truly VALID diagnosis of Depression can only be made when the context of the person's life is taken fully into account and thus the tickbox/checklist criteria of DSM is insufficient for it's purpose.
This might just be the most important book written about Depression since Robert Burton's 'Anatomy of Melancholy' and I would urge anyone with an interest in the subject to read it and take note for the implications of their argument are far-reaching. Also recommended reading on a similiar vein is David Healy's 'The Antidepressant Era.'
Format:Hardcover
I bought this book as a source material for my work as an journalist and it has worked well for it. It is not too complicate or professional so an average person can follow it quite well without any problem. It gives a lots of background info about the process of developing modern psychiatry diagnosing methods.
Most Helpful Customer Reviews on Amazon.com (beta)
Amazon.com:
10 reviews
42 of 44 people found the following review helpful
A must read for clinical researchers and DSM critics
8 Feb 2008
Format:Hardcover|Amazon Verified Purchase
To say I enjoyed this book might be a stretch. There were parts that were laborious because it was like reading a very long journal article on the topic. My effort to get through the book were paid off by how I conceptualize two things - the role of context in classification and the art of criticism without destructive criticism. I will detail both below.
Context: The authors make it clear from the beginning that depression is inappropriately diagnosed these days. Typical behavioral responses to sadness are probably misconstrued as depression. I found that part of the thesis quite compelling. Even more compelling was the fact that the evidence seems to favor their perspective. The point is driven home by anecdotes, data, and theory. I liked the combination because it kept the reader (me) thinking throughout the book.
Criticism: Where I think the authors deserve the most praise is for their delicate and precise criticism of the DSM. They do a remarkable job of detailing the merits of clinical diagnosis while also describing the warts. Unlike most DSM critics who want to throw all classification out, they recognize the importance of mental illness types. I was reminded of Paul Meehl's critique of the antinosological critics (in "Why I don't attend case conferences") while reading this book. These authors did not fall into Meehl's trap. Instead, they offered both sides of the situation and made it clear that their omission of context did nothing to denigrate the DSM specifically. Perhaps they were cautious of the criteria and the application of DSM diagnostic criteria without considering the context and history of the patient.
If you find either point worth reading then buy this book. I plan to make all my graduate students read parts of this book for both points above.
Context: The authors make it clear from the beginning that depression is inappropriately diagnosed these days. Typical behavioral responses to sadness are probably misconstrued as depression. I found that part of the thesis quite compelling. Even more compelling was the fact that the evidence seems to favor their perspective. The point is driven home by anecdotes, data, and theory. I liked the combination because it kept the reader (me) thinking throughout the book.
Criticism: Where I think the authors deserve the most praise is for their delicate and precise criticism of the DSM. They do a remarkable job of detailing the merits of clinical diagnosis while also describing the warts. Unlike most DSM critics who want to throw all classification out, they recognize the importance of mental illness types. I was reminded of Paul Meehl's critique of the antinosological critics (in "Why I don't attend case conferences") while reading this book. These authors did not fall into Meehl's trap. Instead, they offered both sides of the situation and made it clear that their omission of context did nothing to denigrate the DSM specifically. Perhaps they were cautious of the criteria and the application of DSM diagnostic criteria without considering the context and history of the patient.
If you find either point worth reading then buy this book. I plan to make all my graduate students read parts of this book for both points above.
14 of 14 people found the following review helpful
The Loss of Sadness: How Psychiatry transformed normal sorrow into Depressive Disorder
18 April 2009
Format:Hardcover
If you read psychiatric books, this one is excellent (though very academic and clinical), as it discusses subject matter that has been hotly debated for the last decade regarding what the disorder called depression really is, and if it needs to be treated so extremely with antidepressant medications, longterm therapy, etc.
Primarily, this book is written by two very thoughtful professionals who have dedicated their lives to the helping professions, but do not want to see every human thought, feeling and emotion turn into an over-treated disease, disorder or condition. Some mood swings and emotional adjustments are simply normal reactions to life, aren't they?
Primarily, this book is written by two very thoughtful professionals who have dedicated their lives to the helping professions, but do not want to see every human thought, feeling and emotion turn into an over-treated disease, disorder or condition. Some mood swings and emotional adjustments are simply normal reactions to life, aren't they?
9 of 9 people found the following review helpful
A must for anyone in any mental health-related field...
2 Nov 2009
Format:Hardcover|Amazon Verified Purchase
A must for anyone in any mental health-related field, but you know what? I recommend this book to everyone, it's just that well written. Horwitz and Wakefield use arguments from anti-psychiatry, social constructionism, cultural relativism, evolutionary psychology and the interpretation of empirical research to uphold that psychiatry no longer differentiates between normal responses and pathological ones. The topic is extremely interesting and it is developed in a surprisingly easy to understand manner.
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